Experienced Worker SKILLcard

Section 1 - Your occupation

Please tick the box which best describes your occupation. Tick one box only. Building Services Engineering Service & Maintenance Technician/Engineer Commissioning Engineer

Commissioning Technician

Domestic Heating Installer/Fitter/Service Engineer Ductwork Erector/Ductwork Installer*

Gas Fitter (Domestic)

Gas Fitter (Industrial & Commercial)* H&V Fitter*

H&V Fitter/Welder* H&V Installer* H&V Pipefitter* H&V Welder*

Plumber (Domestic) Plumber (Industrial & Commercial)* Refrigeration/Air Conditioning Technician/Engineer

HOW TO APPLY:

1. Please complete sections 1-9 of this form.

2. Hand this form to your employer (not your agency) together with all supporting documents (certificates etc) and ask them to complete section 7. 3. Because you are applying for an Experienced Worker card, you will need to register for a National Vocational Qualification (NVQ) or (in Scotland) a Scottish

Vocational Qualification (SVQ) relevant to the occupation you have ticked on this page. You will also need to carry out an initial profiling with an NVQ/SVQ assessor. The relevant details of this should be included in section 8 of the form.

4. Attach your photograph in section 2. Remember to write your name and National Insurance number on the back. 5. Attach a cheque or complete credit card details in section 9.

Important note: please send certified copies of your certificates with your application. They should be signed and endorsed by your employer.

CHECKLIST:

Once all the relevant sections of this form have been completed help us to get your SKILLcard to you as quickly as possible by checking that your application is complete:

Check 1 - Have you completed all the appropriate sections of this form for the Experienced Worker card you are applying for? Check 2 - Have you provided evidence that you meet the SKILLcard Health and Safety requirements?

Check 3 - Have you provided evidence of qualifications/courses required to support your application? Check 4 - Have the applicant’s and the employer’s declaration both been completed?

Check 5 - Has the Assessment Centre confirmation declaration been completed? Check 6 - Have you included the appropriate fee for your SKILLcard?

Fill in the form using black ink and capital letters. If you have any queries about this form or how to complete it, please check the FAQs section of our website (www.skillcard.org.uk/faqs) or call us on 01768 860406

Engineering Services

SKILLcard application form

Experienced Worker SKILLcard

Section 3 - Health and Safety awareness

To obtain a SKILLcard, you must within two years prior to the date of application for the card have satisfactorily completed the recognised ConstructionSkills/SKILLcard Health, Safety and Environment Test. Alternatively, if you have completed one of the health and safety awareness training courses on the SKILLcard list of approved courses, you may also satisfy the requirements for the issue of a SKILLcard (provided you undertook the course within two years of applying for your card).

Tick one box and enclose relevant certificates:

ConstructionSkills/SKILLcard Health, Safety and Environment Test Other approved course (as listed on the SKILLcard website)

Section 4 - Industry qualifications

Put a tick against each qualification you would like to be considered for inclusion on your Engineering Services SKILLcard. Please send certified copies for verification. 1. Welding Competency (Summit Skills Welding Certificate)

Oxy-Acetylene Metal-Arc 2. Brazing

British Refrigeration Association Code of Practice on Jointing of Copper Pipework for Refrigeration Systems CITB Refrigeration Pipework and Brazing Other

3. Gas Safety Gas ACS 4. HV Switching

HV Switching Certificate

Section 2 - Your details

Please provide the information requested below, and attach your photograph in the space provided. Write your name and National Insurance number on the back of the photograph. Please complete all fields.

How would you describe your ethnic origin?

White Black (African descent) Black (Caribbean descent) Asian (Indian/Pakistani/Bangladeshi) Asian (Chinese) Other

National Insurance number

– – Email address Surname Forenames Address (line 1) Address (line 2) Address (line 3)

Town County Postcode

Mobile telephone number Home telephone number

Please attach your

photograph here

Date of birth

/ /

Date you started in the H&V industry / / Your sex

Male Female

Section 4 - Industry qualifications (continued)

Awareness Course First Aider Qualification 6. Abrasive Wheels

Abrasive Wheels Certificate 7. Other qualifications and courses

Please provide details of any other relevant qualifications you would wish to be considered for inclusion on your SKILLcard (e.g. Certificates of competence in operation of boom and scissor lifts and mobile elevated work platforms, such as those issued by the International Powered Access Federation (IPAF) or by the Powered Access Suppliers and Manufacturers Association (PASMA) and their members etc).

8. Upgrading/Industry Training Scheme

Ductwork Training scheme NJIC Craft Upgrading 9. F-Gas and ODS Regulations

City & Guilds Award in F-Gas and ODS Regulations: Category I (C&G 2079-11) CITB Safe Handling of Refrigerants: Category 1 (CITB J11)

Section 5 - Grade details

Only for applicants employed under the H&V Industry’s Operative National Agreement

If you are employed under the National Agreement for the Heating, Ventilating and Air Conditioning industry and wish to register your grade, please tick the grade in which you are employed. Provided you comply with the grading definitions of Clause 6 of the National Agreement, your grade will appear on your SKILLcard.

Mate

Senior Apprentice Installer Craftsman Senior Craftsman

Section 6 - Applicant’s declaration

I certify that the details on this application are correct and complete to the best of my knowledge. I agree that the information contained on this application form may be used by Engineering Services SKILLcard and related companies in the BESA Group in connection with my application for an Engineering Services SKILLcard and the provision of other services associated with my employment in the building services engineering industry. I acknowledge that the personal information given here will be used for the purpose of processing my application for an Engineering Services SKILLcard, this may include passing on information to employers, labour agencies or training providers and for this purpose, your data may be entered onto a secure database accessible via the website. I also agree that information from this application may be held on a database in accordance with the Data Protection Act 1998.

I agree SKILLcard may contact me from time to time with information about SKILLcard and information regarding updates or additional services available from SKILLcard Ltd and its associated companies. If you do not wish to receive such information please tick here

Signature Date

/ /

Section 7 - Employer endorsement

Section 7 should be completed only by a manager of appropriate seniority within the employing organisation. The applicant must NOT complete this section of the form. If the applicant is unemployed, section 7 should be completed by the applicant’s previous employer.

Tick only those boxes in section 7 which are relevant to this application. Not all boxes may need to be ticked.

I confirm that the applicant named on this form has been known to me personally in the occupation shown on the front page since: Date / / I confirm that the necessary documentary evidence supporting the qualifications indicated in section 4 is attached. In the event that the applicant is

supplying photocopies of the relevant certificates, I also confirm that I have verified them by checking them against the originals, and that I have signed and dated them as authentic.

In the case of an applicant who is seeking to register his/her National Agreement grade on the SKILLcard:

Section 7 - Employer endorsement (continued)

I agree that Engineering Services SKILLcard Ltd may use the information disclosed in this application for the following purposes: • to help improve the content of the SKILLcard website and the service SKILLcard offers;

• for internal audit purposes;

• to provide you with information about SKILLcard and associated industry matters; • to provide businesses with information regarding updates or additional services available

from SKILLcard Ltd and its associated companies.

If you do not wish to receive such information, you may notify us by email at [email protected] or in writing to the address on this form. Name of employer/company

Address (line 1)

Address (line 2)

Town County Postcode

Signature Print name

Position in company Date

/ /

Email address Telephone number

Section 8 - Details of NVQ/SVQ - Assessment Centre confirmation

This section must be completed in all cases

Section 8 should be completed only by an approved NVQ/SVQ assessor or representative of the Assessment Centre carrying out the assessment. Tick box and provide further information requested:

I confirm that I have carried out the profiling of the above applicant in the relevant NVQ/SVQ for the occupation shown on the front page of this form. Title of NVQ/SVQ

Candidate’s NVQ/SVQ registration number Assessment Centre registration number

Name and address of Assessment Centre

Town County Postcode

Name of assessor Telephone number

Position held at Assessment Centre

Signature Date

/ /

Section 9 - Payment details

Use this section to indicate how you intend to pay for your SKILLcard.

Credit/Debit card payment - please complete details below Cheque payment of £40.00 (inc VAT) payable to ‘Engineering Services SKILLcard Ltd’

Cardholder’s name as it appears on the card

Address (line 1)

Address (line 2)

Town County Postcode

Signature Date

/ / Card number

Valid from Expiry date Issue no. Security code (last 3 digits on security strip)

/ /

Card type

Visa Mastercard Eurocard

Please send this form and

supporting documentation to:

Engineering Services SKILLcard

Old Mansion House

Eamont Bridge

Penrith

Cumbria

CA10 2BX

www.skillcard.org.uk

Email: [email protected]

Telephone: 01768 860406

Old Mansion House Eamont Bridge Penrith Cumbria CA10 2BX

www.skillcard.org.uk Email: [email protected] Tel: 01768 860406 EW Occ V1. October 2015